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Improving Safety and Quality for Surgery Patients

During their time in the operating room and in the days of recovery that follow, surgical patients are vulnerable and their safety is of prime importance.

It should come as no surprise then that health organizations and providers in Ontario have turned to a proven program of data gathering, program enhancements and culture change to improve the quality of the care they provide to surgery patients.

Improving Surgical Care in Ontario, a new report from Health Quality Ontario, documents the success shown by The Ontario Surgical Quality Improvement Network in its first 18 months.

The network is a group of Ontario hospitals, including 33 who are involved in what is known as the NSQIP-ON collaborative – institutions who use data supplied by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to compare themselves with their peers and establish continued quality improvement programs. Or as Dr. Michael Lisi, chief of staff at Collingwood General and Marine Hospitals, puts it: “our hospital is joining forces with other leading hospitals to uncover new ways to help our patients get the best results from surgical treatment.”

Launched in January 2015, the Surgical Network has a strategy of combining this high quality data with the best evidence in surgical care and quality improvement methods to support a community of practice that would result in improved surgical outcomes.

To date, results from the Network show this approach has exceeded expectations.

It is worth noting that initial assessment of the ACS-NSQIP database showed that, compared to other participating hospitals, the Ontario collaborative is performing relatively well in many areas including the prevention of:

Prolonged ventilation (ventilation > 48hrs)

Unplanned intubation

Need to return to the operating room

Sepsis after surgery

However, on two key measures – surgical site infection and urinary tract infection – there was clearly room for improvement, as many hospitals in the collaborative had infection rates that were greater than the majority of comparator hospitals.

As a result of these baseline findings, 13 hospitals in the collaborative instituted targeted programs to reduce surgical site infection rates. Such interventions ranged from building effective teams and educating staff and patients, to appropriately removing hair at the surgical site and ensuring the appropriate use of prophylactic antibiotics.

By implementing these initiatives, the hospitals were able to reduce their surgical site infection rate from 3.9% in September 2015 to 3% at the end of September 2016, and many hospitals exceeded the targets they had set for improvement.

A similar success was documented by the four hospitals in the collaborative who identified urinary tract infections (UTIs) as a quality improvement focus. Overall, three of the four hospitals involved in this initiative saw a reduction of UTIs of 51%.

Another major initiative has been implementation of the Enhanced Recovery After Surgery (ERAS) pathways to improve recovery times and outcomes in patients having elective surgery. Being rolled out in 15 hospitals, it is anticipated this work will decrease peri-operative stress, post-operative pain, gastrointestinal problems and infection, and promote early recovery in Ontario’s surgical patients. These reductions in postoperative complications and accelerated recovery will lead to earlier discharge rates.

In support of the work done by the hospitals in the Surgical Network, has been the development of a community of practice. This community pf practice has provided a forum whereby surgeons, nurses, residents and quality improvement staff can come together regularly for in-person and virtual meetings to share information and best practices.

The report provides clear evidence this approach to surgical quality and safety is having a real impact, and with the momentum gained, the Surgical Network can now turn its sights to setting targets as a group.